221 Submaximal Angioplasty Alone Versus Stenting Plus Angioplasty for Symptomatic Intracranial Atherosclerotic Disease a Propensity Score Matched Comparative Study With Long Term Follow-Up

INTRODUCTION: Symptomatic intracranial atherosclerotic disease (ICAD) remains an important cause of recurrent stroke and acute ischemic event. Although the high periprocedural risk of intracranial stenting from recent randomized studies has dampened enthusiasm for such interventions, submaximal angioplasty without stenting may represent a safer endovascular treatment option. METHODS: A prospectively maintained database was retrospectively searched for patients presenting with signs and symptoms of acute ischemic stroke or transient ischemic events. Patients subsequently underwent CT Stroke Study to confirm the diagnosis of symptomatic intracranial atherosclerotic disease. Patient baseline demographic characteristics, procedural details and post-procedure outcomes were recorded. A one-to-one matched propensity score analysis was performed to adjust for treatment selection bias using the nearest-neighbor matching technique without replacement for covariates (baseline comorbidities, previous stroke or TIA, antiplatelet use, anticoagulant use, and baseline percent diameter stenosis). Mann-Whitney U test was performed to compare the procedural parameters and the clinical outcomes between groups. RESULTS: We included 218 patients (Submaximal angioplasty:97 [97 after PSM]; Stenting plus angioplasty:121 [97 after PSM]). After PSM, no difference was seen between the two groups in terms of comorbidities, and initial stroke severity. Submaximal angioplasty group had significantly lower incidence of stroke/TIA secondary to restenosis on follow-up (6.2% vs. 20.6% (OR = 0.87; P = 0.003)), and longer length of follow-up after discharge (4.17 years vs. 2.88 years (OR = 0.98; P = 0.03)) when compared to stenting plus angioplasty group. Both groups had similar rates of intra- (2.1% vs. 6.2% (OR = 0.96; P = 0.15)) and post-procedural complications rates (6.2% vs. 11.3% (OR = 0.95; P = 0.21)). CONCLUSIONS: Submaximal angioplasty alone results in better long-term clinical outcomes in terms of stroke/TIA when compared with stenting and angioplasty for symptomatic intracranial atherosclerotic disease, and represents a potentially promising intervention.